Osteoporosis

Osteoporosis is a bone disease due to increased fragility of bone leading to fracture of bones.

Most cases occur due to unidentified cause (hereditary or genetic) but certain diseases promote thin and fragile bones.  These diseases and treatments include hyperthyroidism, coeliac disease, male hormone deficiency, overactive parathyroid glands, gluten sensitivity and long term oral steroid use.

Osteoporosis manifests as fracture of bone which often causes pain & reduced function.  Often osteoporosis or very low bone strength is present (but undiagnosed) without fracture.

Osteoporosis occurs in over 60% of women over the age of 60 years & 40-50% of males over the age of 60 years.  Bone strength peaks at age approximate 25 years and remains stable in females till menopause when a steep fall in bone strength occurs within 5 years ( as oestrogen levels fall) and then a progressive 1% per year loss of bone occurs.

In males often from the age pf 40 years a steady fall in bone strength occurs over the years.

Osteoporosis occurs as a consequence of bone loss or inadequate bone formation or combination of both.

Treatment for osteoporosis includes optimisation of lifestyle and nutrition.  Exercise (weight bearing), adequate calcium and exposure to sunlight cessation of smoking together with only moderate alcohol intake can aid bone health.

Medical therapies can be divided into prevention of bone loss treatments or bone growth promoting therapies.

Bone loss therapies include

• Bisphosphonates – Oral weekly tablet that slows down bone destruction. Intravenous yearly therapy is also available.
• Estrogen receptor modulator treatment involves daily tablet therapy.
• A 6 monthly injection under the skin with denosumab, a drug that blocks the maturation of bone eating cells.

Bone Stimulating Therapy

• Strontium an oral daily medicine that attaches to bone and stimulates bone growth.
• Parathyroid hormone daily injections for 18 month, the most potent bone stimulating treatment currently available but its availability for subsidisation by the government is very restricted.

How to diagnose

• Osteoporosis is a disease that can be treated.  Its diagnosis is made by the presence of minimal trauma fracture or via imaging by DEXA scan.  The test can be ordered by a GP or specialist.